The Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), the Department of Education (ED) and Sesame Workshop, the nonprofit educational organization behind Sesame Street, have teamed up to launch a new, national public service advertising campaign designed to encourage American children and families to practice healthy habits and to take steps to prevent the spread of the 2009 H1N1 flu virus. The PSAs featured in this campaign can be viewed on www.flu.gov.

On August 9, 2009, the White House charged the Department of Health and Human Services (HHS) in coordination with the Office of the Director for National Intelligence (ODNI) and the Department of State (DoS) to study characteristics and impact of the 2009 Influenza A (H1N1) (refer to as 2009 H1N1) outbreak in the Southern Hemisphere.

Children less than 5 years of age are at increased risk of complications from influenza (flu); the risk is greater among children less than 2 years old. Importantly, infants less than 6 months of age represent a particularly vulnerable group because they are too young to receive the seasonal or 2009 H1N1 influenza vaccine; as a result, individuals responsible for caring for these children constitute a high-priority group for early vaccination.

Technical Report for State and Local Public Health Officials and Child Care and Early Childhood Providers on CDC Guidance on Helping Child Care and Early Childhood Programs Fri, 04 Sep 2009 09:00:00 -0500

This Technical Report provides explanations of the strategies presented in the CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season and suggestions on how to use these strategies. The guidance is designed to decrease exposure to seasonal flu and 2009 H1N1 flu and limit the disruption of the essential service early childhood provides to families.

This situation report provides an update to the international situation as of August 28, 2009. As of August 23, the World Health Organization (WHO) regions have reported over 209,438 laboratory-confirmed cases of 2009 H1N1 influenza virus with at least 2,185 deaths.

Tropical regions of South and Southeast Asia continue to experience geographically regional or widespread influenza activity (represented by countries such as India, Bangladesh, Myanmar, Thailand, Cambodia, Sri Lanka, and Indonesia). Many countries in the region are reporting increasing or sustained high levels of respiratory disease, and a few (Thailand and Brunei Darussalam) have begun to report a declining trend in the level of respiratory diseases.

Objective: To provide updated guidance on the use of antiviral agents for treatment and chemoprophylaxis of influenza including 2009 H1N1 influenza infection and seasonal influenza, and assist clinicians in prioritizing use of antiviral medications for treatment or chemoprophylaxis for patients at higher risk for influenza-related complications. Additional revisions to these recommendations should be expected as the epidemiology and clinical presentation of 2009 H1N1 influenza is better understood. This guidance can be adapted according to local epidemiologic data, antiviral susceptibility patterns, and antiviral supply considerations. Clinical judgment is always an important part of treatment decisions.

On September 8, 2009 CDC updated its recommendations for the use of influenza antiviral medicines to provide additional guidance for clinicians in prescribing antiviral medicines for treatment and prevention (chemoprophylaxis) of influenza during the upcoming 2009-2010 flu season. These recommendations are intended to help clinicians prioritize use of antiviral drugs for treatment and prevention of influenza. In general, the priority for the use of antiviral medications this season continues to be in persons at increased risk of influenza-related complications as outlined in the antiviral recommendations posted on May 6, 2009.

WASHINGTON (Reuters) - Patients who have flu-like symptoms and are having trouble breathing should get quick treatment with the antiviral drugs Tamiflu or Relenza, even before getting a flu test, U.S. officials said on Tuesday.

And doctors should consider setting up a system so that patients most likely to become severely ill from H1N1 swine flu have a prescription on hand so they can just call up to get the go-ahead to take the drugs if they develop symptoms, the U.S. Centers for Disease Control and Prevention said.

"Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza," the CDC says in updated guidelines, available here

"The very young and very old, people with chronic medical conditions and pregnant women in general ought to be treated with antivirals when they have an influenza-like illness," the CDC's Dr. Anne Schuchat told reporters.

But most people will not need any treatment at all for H1N1 because most of those infected so far have recovered on their own. "They can be cared for with mom's chicken soup at home, lots of fluids and rest," Schuchat said.

The latest guidance suggests officials are keen to make sure people who need it get very quick treatment, while making sure people who do not need the drugs do not abuse them.

Both GlaxoSmithKline's Relenza and Roche AG's Tamiflu can help save the lives of patients severely ill with any influenza, if given within a day or so of symptoms starting. They can also ease the misery of milder cases and even prevent flu if people take it just after exposure.

DEVELOPING RESISTANCE

But supplies are not infinite and health officials worry that the more people take them, the quicker the virus will evolve resistance, rendering them useless. Two older flu drugs, amantadine and rimantadine, are already useless against seasonal flu.

The CDC is clear that some people should take the drugs prophylactically -- to prevent infection. That includes some healthcare workers and people with high-risk conditions such as asthma who know they were in close contact with an infected person.

But the new guidance adds an option to watch and see if the person gets a fever. "Instead of the preventive use of antivirals, clinicians may consider watchful waiting," Schuchat said.

A vaccine against H1N1 swine flu is being tested but will not be available until mid-October. The CDC recommends that about 160 million people line up for the first doses starting then.

"Virtually all the influenza circulating now in the United States is the 2009 H1N1 strain," Schuchat said. It has not mutated and the vaccine is still a good match, she said.

She said only a handful of cases of resistance to Tamiflu, known generically as oseltamivir, have been reported.

In the United States, 24 elementary, middle or high schools closed because of H1N1 outbreaks last week, letting 25,000 students out of class. The CDC advises against closing schools unless so many students or staff become ill that the school is overwhelmed.

The virus "is causing increased disease and it is time to pay attention," Schuchat said.

AMSTERDAM (Reuters) - The Dutch government said on Tuesday it would receive fewer than half of the H1N1 flu vaccines initially expected in the first delivery from its most important supplier, Swiss vaccine maker Novartis.

The Dutch government decided in June to buy 34 million pandemic vaccines against the H1N1 flu virus, sufficient for two doses per person, agreeing with producers that the vaccine must be available by the end of 2009.

"The first supply of the vaccines at the end of October ... contains fewer vaccines than expected," the Dutch Health Ministry said in a statement, adding that Novartis had informed the World Health Organization of the shortfall last week.

The Dutch government expects it will receive in the first batch less than half of the ordered number of vaccines in October, amounting to between 6 million and 10 million vaccines.

Dutch government spokesman Toon van Wijk said Novartis was contracted to supply 18 million vaccines by the end of October, while British firm GlaxoSmithKline was contracted to supply 2 million.

He said GlaxoSmithKline is still expected to supply its contracted number of vaccines by the end of October.

Dutch authorities are expecting a delivery of vaccines every month after that until their order has been fulfilled, but Van Wijk did not say when the last delivery is expected.

"Current yields from the reassortant strain are lower than expected. We are working diligently to make adjustments to improve the yields," Novartis said in an attached statement.

It added that pending approval from regulatory authorities and evolution of the yields, it expected deliveries to begin to governments in the fourth quarter and continue into 2010.

The Dutch government has not yet decided whether one vaccine will be sufficient or whether people will need two doses, but is buying enough vaccines to vaccinate the population twice over.

Novartis said last week a single dose of its swine flu vaccine might protect against the virus, raising hopes that potentially tight supplies could go further when mass immunization starts.

The company said a single dose of the Celtura H1N1 vaccine, boosted with an immune-stimulating compound called an adjuvant, produced desired effects in 80 out of 100 volunteers.

The new H1N1 strain of flu, declared a pandemic on June 11, could eventually infect 2 billion people, according to World Health Organization (WHO) estimates.

ALBANY, N.Y. — Tens of thousands of health care workers who typically avoid flu shots are under more pressure than ever to get vaccinated as hospitals and clinics prepare for a spike in swine flu cases this fall and winter.

This Sept. 2, 2009 photo shows Sandra Morales, a registered nurse, outside Beth Israel Medical Center in New York. Morales, a labor and delivery nurse in New York City, had her last flu shot 16 years ago. She says she got the flu anyway. She objects to New York's new law, requiring all health workers to get immunized against seasonal and swine flu, saying it infringes on free-choice rights. "It's crossing the line and I'm opposed to that." (AP Photo/Tina Fineberg)

Roughly half of health workers skip the immunizations, raising two concerns: If doctors and nurses get sick, who will treat what could be millions of Americans reeling from seasonal or swine flu? And could infected health workers make things worse by spreading flu to patients?New York, the first state to be hard-hit by swine flu, is requiring all health workers to get immunized against both types of flu. Other states are weighing whether to follow suit.

But shots for all health workers may not be an easy sell.

Fewer than half of them got flu vaccinations last year, according to a Centers for Disease Control and Prevention survey of about 1,000 workers. That includes physicians in clinics, lab technicians, respiratory therapists and home health aides. Rates are highest among doctors and nurses in hospitals — 70 to 80 percent, but the overall rate shows many still shun the shots.

Why? The reasons vary from safety concerns to skepticism over vaccine effectiveness.

Sandra Morales, a labor and delivery nurse in New York City, had her last flu shot 16 years ago. She says she got the flu anyway.

She objects to New York's new law, saying it infringes on free-choice rights. "It's crossing the line, and I'm opposed to that."

Hospital workers "are at risk for being exposed to many, many diseases," she said. "Imagine if we had to take a vaccine for everything that comes in the door."

Morales worries she might lose her job if she refuses — it will be up to individual clinics and health centers to decide how to enforce the law. She has until Nov. 30 to get her shots. Both the seasonal flu vaccine (available this month) and swine flu vaccine (expected in October) are required for workers in hospitals, treatment centers and in home care.

That may mean three separate shots, if the swine flu vaccine requires two doses to be effective. Testing in the U.S. is still under way to determine the dose.

The uncertainty about the new swine flu vaccine has added to the challenge.

"If health care workers have concerns about the safety and efficacy of a vaccine that has been aroundfor decades, I'm sure they're going to have those same concerns about a vaccine that we've never used before," said Dr. Gregory Poland, a Mayo Clinic vaccine specialist.

He says health workers are ethically obligated to get vaccinated for both kinds of flu. He supports requiring them. New York, which had the first big surge of swine flu cases in the spring, is the only state doing that, although some states are considering the issue.

The theory that health care workers could spread the infection is supported by only isolated evidence, but the fear persists.

Some large hospitals have adopted rules requiring employees to get flu shots. Loyola University Medical Center near Chicago and Charleston Area Medical Center in West Virginia recently joined a handful of hospitals that have made seasonal flu shots mandatory for all workers. Some also plan to include swine flu. Several infectious disease groups support required flu vaccination for health workers.

Federal health officials say health care workers are among the priority groups for flu shots, but the government is not ordering anyone to get shots.

In New York, Health Commissioner Dr. Richard Daines notes that health employees are already required to get other vaccinations, including rubella and measles shots.

Under the new flu shot law, workers can opt out only for certain health reasons, including an allergy to flu shots.

Bill Van Slyke of the Healthcare Association of New York state, which represents hospitals, said hospitals have concerns about what action they can legally take if staffers refuse vaccinations.

"We don't expect that to happen to any significant degree — we think most recognize the value of doing this, but there are one or two challenging scenarios out there," he said.

Dr. Brian Currie, an infectious disease specialist at Montefiore Medical Center in the Bronx, supports the law but said including swine flu vaccinations could be a headache.

"It means twice as much time, tracking people to make sure they get a timely second vaccination" if required. "It's a lot more work," Currie said. "We'll do our best."

Though infectious disease specialists say they have seen no serious complications during the swine flu vaccine testing that began last month, some critics say it is being fast-tracked without adequate safety tests. Some also fear a repeat of a rare paralysis called Guillain-Barre syndrome that occurred during a 1976 swine flu vaccination effort, though there is no evidence the vaccine caused that condition.

Dr. William Schaffner has had two swine flu shots during testing at Vanderbilt University, with no ill effects. The current flu virus is molecularly different from the one circulating in 1976, so Schaffner, who has consulted for the swine flu vaccine makers, said similar problems are unlikely.

Deborah Burger, a president of the California Nurses Association/National Nurses Organizing Committee, said safety concerns persist. That union, with 86,000 members in 50 states, is weighing whether to support required flu shots for nurses.

She said the union believes patients should be protected but also wants to protect nurses from any potential vaccine-related problems, saying, "It's a difficult tightrope to walk right now."

More than 550 U.S. deaths have been attributed to the new H1N1 swine flu. So far it does not appear to be more deadly than regular seasonal flu. Projections for the upcoming season vary. A worst-case scenario from a scientific panel advising the White House said up to half the population might get sick and up to 90,000 might die.

An estimated 36,000 Americans die from regular influenza each year.

At Virginia Mason Medical Center in Seattle, the first U.S. hospital to require flu vaccination for staffers, employees who object must wear a face mask during flu season or possibly be fired. Only a handful of objectors have been fired, all in the first season, 2005-06, said hospital spokeswoman Alisha Mark.

Dr. Joyce Lammert, Virginia Mason's chief of medicine, said if testing shows the new vaccine is safe and effective, and if supplies are adequate, the hospital will make that mandatory, too.

"We feel that getting immunized is so important," Lammert said. "In some ways, I'm glad H1N1 is out there. It raises awareness of the seriousness of the disease."

Mere - you mean the healthcare workers in NY haven't had to take flu shots in the past? In the hospital I worked at ALL clinical employees were required to get flu shots and ALL other employees were encouraged to get them. This has been the practice for over 10 years, maybe longer.

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Mere - you mean the healthcare workers in NY haven't had to take flu shots in the past? In the hospital I worked at ALL clinical employees were required to get flu shots and ALL other employees were encouraged to get them. This has been the practice for over 10 years, maybe longer.

Klaas, flu shots for healthcare workers have not been mandatory across the United States......although I do think more hospitals are looking at it this year.

These facilities are also looking at whether to control visiting by children and young adults and certainly by anyone who seems to be ill with flu-like symptoms.

DES MOINES, Iowa - Operating room nurse Pauline Taylor knows her refusal to get a flu shot is based on faulty logic.

But ever since she got sick after getting a shot a few years ago, she's sworn off the vaccine.

"I rarely get sick. The only thing I could narrow it down to is that I had gotten this shot," said Taylor, who works at University Hospitals and Clinics in Iowa City. "I know that it's not a live virus. It just seemed pretty coincidental."

Such stories frustrate Dr. William Schaffner.

As chairman of the Department of Preventive Medicine at Vanderbilt University, he hears that kind of talk frequently and knows it's in part to blame for a surprising statistic — nearly 60 percent of health care workers fail to get a flu shot.

That's despite recommendations from the Centers for Disease Control and Prevention that all health care workers get vaccinated, from hospital volunteers to doctors.

This current article addresses healthcare workers receiving seasonal flu shots - and talks about them then getting the flu vaccine (a total of three shots) - so that there are healthy individuals available to care for those who are ill.

ALBANY, N.Y. – Tens of thousands of health care workers who typically avoid flu shots are under more pressure than ever to get vaccinated as hospitals and clinics prepare for a spike in swine flu cases this fall and winter.

Roughly half of health workers skip the immunizations, raising two concerns: If doctors and nurses get sick, who will treat what could be millions of Americans reeling from seasonal or swine flu? And could infected health workers make things worse by spreading flu to patients?

New York, the first state to be hard-hit by swine flu, is requiring all health workers to get immunized against both types of flu. Other states are weighing whether to follow suit.

In the temperate region of the southern hemisphere (represented by countries such as Chile, Argentina, Australia, New Zealand, and South Africa), influenza activity continues to decrease or return to baseline.

Schools....This article is from the World Health Organization. Click on the link below to read the entire article.

Measures in school settings

Pandemic (H1N1) 2009 briefing note 10

11 SEPTEMBER 2009 | GENEVA -- WHO is today issuing advice on measures that can be undertaken in schools to reduce the impact of the H1N1 influenza pandemic. Recommendations draw on recent experiences in several countries as well as studies of the health, economic, and social consequences of school closures. These studies were undertaken by members of a WHO informal network for mathematical modelling of the pandemic.

When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.

The federal Centers for Disease Control and Prevention has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer — especially at home where the risk of spreading the germ is highest.

Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said

This study shows you're not contagious for a day or two. You're probably contagious for about a week," said Gaston De Serres, a scientist at the Institute of Public Health in Quebec.

He presented one of the studies Monday at an American Society for Microbiology conference. It is the first big meeting of infectious disease experts since last spring's emergence of swine flu, which now accounts for nearly all of the flu cases in the United States. More than 1 million Americans have been infected and nearly 600 have died from it, the CDC estimates.

It is unclear whether the new research will lead the CDC to rethink its advice on how long people with swine flu should hole up. Long breaks from school and work do not seem worth it for a virus that now seems to cause mostly mild illness, said the CDC's flu chief, Nancy Cox. Swine flu is spreading so widely now that confining the sick does less good, she said.

"We tried to have our guidance balance out all of these factors," she said. "It's just virtually impossible not to have virus introduced into settings such as schools and universities."

Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug.

"It's probably realistic that this virus sheds much longer than seasonal flu," said Dr. Jonathan McCullers, an infectious diseases specialist at St. Jude Children's Research Hospital in Memphis, Tenn.

Three reports suggest this is so. De Serres and other researchers in Canada took nose and throat swabs from 43 patients with lab-confirmed flu and dozens of other sick family members.

On the eighth day after symptoms first appeared, 19 to 75 percent showed signs of virus remaining in their noses, depending on the type of test used.

"This proportion appears to be very big, and it is," but it's not clear how much virus is needed to actually spread flu, so the lower number is more reliable, he said.

Dr. David C. Lye reported on 70 patients treated at Tan Tock Seng Hospital in Singapore. Using a very sensitive test to detect virus in the nose or throat, he found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all.

A third report came from Dr. Guillermo Ruiz-Palacios of the National Institutes of Medical Science and Nutrition in Mexico, where the first cases of swine flu were detected.

Infected people "shed the virus for a very, very long time," often for more than a week after the start of symptoms, he told the conference. This was especially true of obese people, and patients who started on medicines longer than two days after symptoms first appeared.

The new reports suggest a longer contagious period for swine flu, but how long is not clear, Cox said. Even with it in your nose, "you might not be shedding enough virus to infect other people," she said.

That is why signs like coughing may matter more, De Serres said.

"Contagiousness varies, not only with the presence of the virus, but the other symptoms that would make you transmit," he said.

Swine flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, and sometimes diarrhea and vomiting. Young children may be cranky, less playful or not eat as much as normal, the CDC advises.

The agency's advice to stay home for a day after fever breaks does not apply to health care settings. There, confinement for seven days from the start of symptoms — or until they go away, whichever is longer — is still advised.

People who have had swine flu should cover their mouths when they cough or sneeze and wash their hands a lot once they do return to work and school, the CDC says.

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This situation report provides an update to the international situation as of September 11th, 2009. As of September 6th, the World Health Organization (WHO) regions have reported over 277,607 laboratory-confirmed cases of 2009 H1N1 influenza virus (2009 H1N1) with at least 3,205 deaths, which is an increase of over 23,401 cases and at least 368 deaths since August 30th.

Story Highlights NEW: FDA has approved applications from four manufacturers to make vaccine

Director of CDC says first doses of vaccine should be ready in about three weeks

Researchers concluded a single injection would suffice to protect against virus

Pregnant women, children and anyone with health conditions should get shot

updated 16 minutes ago

ATLANTA, Georgia (CNN) -- The Food and Drug Administration has approved applications from four manufacturers to make H1N1 flu vaccine, the secretary of the Department of Health and Human Services said Tuesday.

The vaccine is expected to be available in about three weeks, according to the CDC director.

"We will have enough vaccine available for everyone," Kathleen Sebelius told the House Energy and Commerce Committee.

The plan is to begin the large-scale vaccination program in mid-October in as many as 90,000 sites, though limited amounts of the vaccine are expected to be available a week to 10 days earlier, she said.

Monday, the director of the nation's top disease agency told CNN the vaccine will be available earlier than had been expected.

"We think the first doses of some of the vaccine forms should be available in about three weeks," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Previously, the CDC had been predicting the vaccine would not be available before middle or late October.

Frieden said that the vaccines appear to confer protection from the virus eight to 10 days after they are administered.

The news about the vaccine against H1N1, also called swine flu, comes a week after researchers concluded that a single injection would suffice to protect against the virus.

Health officials are urging that pregnant women, school-age children and anyone with underlying health conditions, like diabetes, heart disease or lung disease, get the swine flu shot. See which states are showing the greatest swine flu activity »

Frieden said it appears that health workers will be able to administer the H1N1 vaccine at the same time that they administer the shot against seasonal flu.

Don't MissH1N1: Fighting swine flu Feds update H1N1 antivirals guidelines The symptoms of seasonal flu are similar to those of swine flu, and patients and their caregivers need not know which one they have, he said.

"The key messages are the same in either case: If you're sick, stay home," he said. "If you're severely ill -- and that means you have trouble breathing, you have severe illness, your fever comes back or you have one of those underlying conditions like diabetes or people with special health care problems, like children with disabilities, that make it difficult for them to breathe -- then see your doctor right away."

Health LibraryMayoClinic.com: Swine flu (H1N1 flu) The timing is important because 11 states already are reporting widespread flu activity. "We wish we had the vaccine today," Frieden said.

He said flu vaccines have a good safety record. "Literally, hundreds of millions of people have gotten the flu vaccine, and certainly my kids will be getting the H1N1 vaccine when it becomes available for everybody."